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Our modules include:

Assess a Medical Claim – R1840.00

Purpose:

This module is intended for medical claims assessors and learners in service centres who are required to respond to queries about medical claims. It requires learners to use insight in applying medical knowledge to process a medical claim.

The qualifying learner is capable of:

• Using medical reference guides to access information.
• Explain how scheme rules apply to the payment of a claim.
• Investigate the most commonly occurring medical conditions in South Africa.
• Explain basic terminology relating to medical claims.
• Process a medical claim.

The typical scope of this module is:

• Current codes include procedural, diagnostic and consumable codes and related tariffs/guidelines.
• Irregularities in a claim include, but are not limited to, procedures by gender and age, exceptionally high claims, cosmetic claims, anaesthetics, over servicing and over utilisation.
• User rights and confidentiality relate to information, staff, information on medical conditions and membership status.
• Conditions applied to Prescribed Minimum Benefits refer to service providers and medication.

Explain the Cycle of a Medical Claim – R1310.00

Purpose:

This module is intended for learners who assess medical claims. It will be useful for intermediaries and service centre agents in Healthcare Benefits Administration.

The qualifying learner is capable of:

• Explaining the origin of medical scheme claims.
• Describing the different routes followed by medical claims.
• Analysing a complex medical claim.
• Investigate the storage and retrieval of claims related documents in a Healthcare Benefits.

Course Outcomes:

• Complex claims include, but are not limited to, MVA, ex gratia, foreign claims and special cases such as orthodontic, oncology, trauma and HIV/AIDS.
• Control measures include, but are not limited to, the Medical Schemes Act, Scheme Rules, options and limitations of benefits.

Utilise Clinical Coding Terms, Rules and Conventions for Diagnostic and Procedure Codes – R2050.00

Purpose:

The skills, values and knowledge reflected in this module is required by people in the field of diagnostic and procedural coding. Learners would be able to contribute to quality data in diagnostic and procedural coding by utilising terms, rules and conventions for ICD and procedural coding.

Course Outcomes:

• Extrapolate the applicable clinical coding terms, rules and conventions for the interpretation of the relevant ICD and Procedure Codes.
• Explain the rationale of the applicability of Clinical Coding terms, rules and conventions for the assignment of the relevant ICD and Procedure Codes.
• Apply different applicable Clinical Coding terms, rules and conventions when assigning ICD and Procedure Codes, the Medical Schemes Act, Scheme Rules, options and limitations of benefits.

Analyse Clinical Information and Assign ICD and Procedure Codes – R2260.00

Purpose:

The skills, values and knowledge reflected in this module is required by people in the field of diagnostic and procedural coding. Learners would be able to contribute to provide quality services in diagnostic and procedural coding by analysing clinical information and assigning ICD and Procedure Codes.

Course Outcomes:

• Assign accurate ICD and Procedure Codes to health and data records.
• Assess the impact of assigning inaccurate ICD and Procedure Codes.
• Apply rules, conventions and medical terminology when assigning ICD and Procedure Codes.

*Clinical information includes and is not limited to health records, medical reports, and medical terminology.

Explain the Use of Coding in Healthcare Benefit Administartion – R2100.00

Purpose:

This module introduces the concept of coding as used in Healthcare Benefits Administration. It is useful for medical claim assessors, medical practitioners and intermediaries.

The qualifying learner is capable of:

• Explaining the concept of coding as used by Healthcare Benefits Administration.
• Explaining the diagnostic coding system.
• Explaining the procedural coding system.
• Explaining consumable coding systems.
• Applying knowledge of medical terminology, anatomy and physiology to the use of coding systems.

Apply Knowledge of the Musculo-Skeletal System to Assess Risk  – R1260.00

Purpose:

This module requires learners to have the background knowledge required to assess a long-term medical risk. It will be useful for underwriters, life claim assessors, reinsurers, medical claims assessors who need to apply knowledge of the musculo-skeletal system to assess long term risk.

The qualifying learner is capable of:

• Explaining the anatomy and physiology of the Musculo-skeletal system.
• Explaining the main conditions and impairments related to the Musculo-skeletal system.
• Interpreting evidence related to Musculo-skeletal conditions and impairments.
• Applying knowledge of the Musculo-skeletal system to assess risk.

Describe the Control of Fraud in Healthcare Benefits Administration – R1520.00

Purpose:

This module introduces the concept of fraud and its control in Healthcare Benefits Administration and is intended for medical claims assessors and learners in Medical Scheme Administrations.

The qualifying learner is capable of:

• Describing fraud as it occurs in Healthcare Benefits Administration environment.
• Explaining legal aspects relating to fraud Healthcare Benefits Administration.
• Explaining internal processors relating to the investigation of fraud in Healthcare Benefits Administration.
• Analysing trends and the impact of fraud in a Healthcare Benefits Administration environment.
• Explaining control mechanisms used to contain fraud in Healthcare Benefits Administration.

Describe Healthcare Cover in South Africa – R1000.00

Purpose:

This module requires detailed knowledge of the main products offered by Healthcare Benefits Administration. It will be useful for intermediaries, learners in medical scheme administration, trustees and learners in call centres.

The qualifying learner is capable of:

• Explaining the difference between a medical scheme and medical insurance.
• Researching the move from traditional to new generation medical schemes.
• Explaining the benefits that are covered by medical schemes.
• Explaining and use the correct context terminology used in the industry.

Describe Managed Care as it is applied in Medical Scheme Administration in South Africa – R1260.00

Purpose:

This module introduces the concept of managed care in Healthcare Benefits Administration. It will be useful for medical claims assessors, intermediaries and learners in Healthcare Benefits Administration

The qualifying learner is capable of:

• Describing the rationale for managed care.
• Explaining the prinicpals of managed care.
• Describing different aspects of managed care programme.
• Analysing the advantages and disadvantages of managed care.

Introduction to Billing & Coding (The Basics) – R525.00

Introduction to Billing & Coding (Paediatricians) – R525.00

Introduction to Billing & Coding (Cardiothoracic Surgeons) – R525.00

Introduction to Billing & Coding (Cardiologists) – R525.00

Introduction to Billing & Coding (Urologists) – R525.00

Introduction to Billing & Coding (Opthalmologists) – R525.00

Introduction to Billing & Coding (Physicians) – R525.00

We specialize in training, upskilling and educating the Healthcare Industry.